## TRANSMITTA L of OMAHALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R

SAI D #: /? 

# ^?^^t
. Date : 

# 11 \n ^ k^
Address : Remediatio nContractor : Coasta l Environmenta l Group
_ Year : 200 8
SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o ofpropert y (DVD ) Executiv e Summar y 

# y EPA-provide dpropert y sketc h Signe dAcces s Agreemen t for subjec t propert y Signe dAcces s Agreement(s ) for adjacent propert y Restoratio nAgreemen t Settlemen t document s (i.e. , for damag e or to replac e plants , etc. ) Confirmatio ndat a Photograph s L>re^-j2^n/iJ/l±lGr { Q-CAUiUniJY \ 

## i / As-buil t sketc h 

# y Satisfactory restoratio nsigne dby Propert y Owne r 

# y Propert y close-ou t chec k Hs t signe dby EP A Descriptio nofarea s no t meetin g RO D cleanu p criteri a 

# y Utilit y clearance s Property informatio nfromDougla s County Assessor' s Offic e 

# y 4031647 0 

# iliii i n Superfun d 

### signatur e 

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# m ^
Propert yAcces s Checklis t Propert y ID : 2gqp,^ ^ nWOR K STARTE D ON : / /_ Propert y Address : ;;)^^>- ^ Q\A\A nWOR K COIVIPELTE D ON : / /
_
Owner : fa^^^^^r S i fiao\ Renter : Address : 

## 2.1Z5 l^»(U\ i Phone : Fax : Cell/Pager : Phone : 

## ^"W'-^TtX Additiona l Information : Fax : Cell/Paiier :
O Notificatio nLette r Sent : / / By : 0 Acces s Agreemen t Signed : % 1 lA/C % 

### ^y-9c
. \/ \Restoratio nAgreemen t Signed : / / By : 1 1 Topsoi l Samplin g (i f a|)|)licablc ) / / By : [ UDisposal Samplin g (if applicable ) / / By : 1 1 Gaide nSamplin g (if a()|)licable ) / / By : 1 { ^ Utility Clearanc e 

## Called: ^/2i,/.0 8 

## »>=€ ) Zftr « 1 2 1 1 n Video/Photo s (Before ) Video/Photo. s (During ) 

## On:_3./ X On : / 

## /J i / 

## ^y-^.u jAiy'lu ^ { ' By : nVideo/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : n nPropert y Completio nAgreemen t Signed : / / Bv :

• Fina l Repor t I.s.sued : / / B.v : Ai r Monitorin g ( a s applicabl e ) 1 1 Communit y 

### D Cro v On : / / 

### By : 1 Results : [ 1 LJ Communit y D CixM> > On : / / Bv : 1 Results : ] 1 Q Communit y nCre w On : / / By : Results :

Omah a Lea d Sit e•


## CONTAC T FOR M Propert y I D #38<^?^ U Propert y Address : 

# a^i aOhi n Initia l Contact : Date : Time : Action : Secon dContact : Date : Time : Action : Fina l Contact : Date : Time ; Action : Fina l Action : Transmi t t o EP AD Othe r Action : D


# Cncen^r S4-, PmJl .34l-aa?, l O Y:^^\-Altr,Kt o Comment : Owne r Commen t (s) :
Sit e -^S S Calle dUf+miSSQd e Coordinato r ^ Commen t (s) :

### Dougla s County Accoun t Infojaatio n Pag e 1 of 2 )j||^ t Dougla s County , Nebrask a Propert yRecor d - R092048000 0 Prin t Repor t NE WFeatur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t of52n d S t - VJewO n Ma p Informatio n i s vali d a s of2009-4-1 6 Treasurer' s Ta xRepor t Ne wFeatur e -•-•- > Aut o Sale s Searc h Owne r CIT YO F OMAH A PLANNIN G DEP T#111 1 1819FARNAMS T OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 204 8 000 0 0 9 Accoun t Type : E xGovernmen t Parce l Number : 092048000 0 Parce l Address : 221 2 OHI O S T OMAH AN E 68110-000 0 Lega l Description : DENISE S AD D LOT1 8 BLOC K1 5 0 X 12 2 Valu e Informatio n Lan d Improvemen t Tota l 200 8 $0.0 0 $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 $0.0 0 200 6 $4,800.0 0 $700.0 0 $5,500.0 0 200 5 $4,800.0 0 $700.0 0 $5,500.0 0 200 4 $4,800.0 0 $2,800.0 0 $7,600.0 0 200 3 $4,800.0 0 $2,800.0 0 $7,600.0 0 Sale s Informatio n Sale s Date : 2008-07-3 1 Dee d Type : \ND U Book : 200 8 Page : 07750 7 Price : $38,320.0 0 Grantor : GREATE R S TPAU L MINISTRIE S IN C Grantee : CITYO F OMAH A Valid/Invalid : Invali d Exclusio n Reason : Multipl e Parce l Sal e Sale s Date : I 2003-05-3 0 Dee d Type : W D BooAr : 200 3 Page : 10363 1 Price : $6,000.0 0 Grantor : Stace yAnderso n


### http://douglasne.mappmg-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092.
. . 5/2/200 9

### Dougla s County Accoun t Infoj|^tio n Pag e 2 of 2

Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/Invalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/lnvalid : Exclusio n Reason : Sale s Date : Dee d Type : Price : Grantor : Grantee : Valid/lnvalid : Exclusio n Reason : Lan d Informatio n Acre s S F 0.1 4 Greate rSt
. Pau l Ministries , Inc
. Vali d

2002-12-1 9 W D $1.0 0 Pear l Taylo r Stace yAnderso n Invali d SooAr ; 200 3 Page : 10354 2

2001-04-1 2 Q C $1.0 0 Book : 217 7 Page : 73 8

Invali d No n Bon o wit h Do cStamp s 2000-04-2 4 D Book : $7,000.0 0 215 0 Page : 08 5

Vali d

6100. 0 Unit s 1. 0 Dept h 122. 0 Widt h 50. 0 Vacan t N o



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092.
. . 5/2/200 9Pag e 1 of 2

Creat e Anothe rTicke t Bac k t o Irt h Interne t Sen d Emai l


### YOU RTICKE T NUMBE RI S 2117116
. Origina l Cal l Date : 8/26/0 8 Time : 3:3 9 p m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 8/28/0 8 Time : 4:1 5 p m State : N E County : DOUGLA S Place : OMAH A Address : 221 2 Street : OHI O S T Twp : 15 NRng : 13 E Sect-Qtr : 09-SE,10-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remidiatio n Locatio n o f Work : LOCAT E ENTIR E PROPERT Y AL L TH E WA Y T O TH E STREET . Remarks : FAX AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R PROPERT Y Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : coasta l Dept h o f Excavation : 4f t Come r Lot : N Front : Y Rear : Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N CXCAT V MAGELLAN MUDO l OMAHACO F OPPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Number Utilit y Typ e Day : 402934046 9 CXCAT V CO X COMMUNICATIONS , IN C HEID I Alt : 402934046 9 Emerg : 402932975 7 Day : 918574709 8 

### MAGELLA NMAGELLA NMIDSTREA M PARTNER S L P TONYAAlt : Emerg : 918574709 8 Day : 402504782 3 MUDO l METROPOLITA NUTILITIES DISTRIC T SAND Y Alt : Emerg : 402504794 6 Day : 402444719 7 OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R RO NAlt : 402444516 1 Emerg : 402444516 0

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/26/200 8

### Pag e 2 of 2 Day : 406728934 3 0PPDGPR5 OMAH APUBLI C POWE RDISTRIC T N AAlt : 888728934 3 

### Emerg : 406728934 3 Day : 406728934 3 QLNNEIC QWES T LOCA LNETWOR K

N AAlt : 

### Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS.
. . 8/26/200 8

# As-Buil t Drawin g C OAST AL 

# Omah aLea dSuperfun dSit e ENVIHONMENTA L CMOUP
. INC
. 

## 2898 6 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h 0 Poo r Samplin g Address : 221 2 OHI O S T r~ | No t pain t Sampl e Numbe r Lea d Sampl e Sample s Collecte d Lft, B Concentratio n Collecte d Firm : RYASCPXA-2898 6 F l 3C> q pp m 

### D Date : &//7/A 7 RYBSCPXA-2898 6 F 2 pp m 

### 3 1 1 D Time : 

### 2.lbf m RYCSCPXA-2898 6 B l pp m Sample s Analyze d RYDSCPXA-2898 6 B 2 pp m 

# n RDZSCPXA-2898 6 D Z pp m 

# i n XR F Unit : L^HT
. Book : 19, ^ RogoopxA-eosoo—e e pp m 

# n n n Date : <= i jT. ! I O l RPZOCPXA.2090 0 P Z pp m 

# n Tinfie : P M 

### D Staff : AtyU/ " Numbe ro f Sample s = 5 Legend : F 1 = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Left
. B 2 = Bac k Righ t D Z = Dri p Zone
. G Z = Garden , P Z = Pla y A n quadrant s are a s viewe d Uz^^ffR,V^ \ facin g property OLS#:28§5 & 

# ENTERE D Dat e Excavated : 9/15/200 8 dat e USEP ASigne d Off : 1/28/0 9 

### AD 6 2 TZPD 7 Are a Sodde d 336 5 s q f t

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### Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p In c

## 2898 6 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e •Good 

### Sit e Sketc h 0 Poo r Samplin g Address : 221 2 OHI O S T Q No t pain t Lea d Sampl e Sample s Collecte d Sampl e Numbe r Ccxicentratio n Collecte d LA B Fir m 

## JtM__E^_C6
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## ^/{7/n 7 RYBSCPXA-2898 6 F2 

## 3 1 1 pp m Tim e 

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## D Sample s Analyze d RYDSCPXA-2898 6 B 2 pp m 

## D RD2SCPXA-2898 6 D Z pp m 

## D XR F Uni t <^*^ Z Book : /9 3 

### RqgoopXA-eosoo o e pp m 

# a D Dat e <^IZ I lO l RP20CrXA-2090 0 P 2 pp m 

## D Tim e 

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# o Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z • Garden , P Z = Pla y A

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## 2898 6 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e •Goo d 

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### Sample s Collected LA B Concentratio n Collecte d 

### Firm : j^ M FRC£ 7 RYASCPXA-2898 6 F l pp m 

## D Date: &//7/A 7 RYBSCPXA-2898 6 F 2 

## 3 1 1 pp m 

## D Time : Z • 1 3 p m RYCSCPXA-2898 6 B 1 pp m 

## D Sample s Analyze d RYDSCPXA-2898 6 B 2 

## 6*f 0 pp m 

## D RDZSCPXA-2898 6 D Z pp m 

## D XRF Unit : LS'j2
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# n D Tim e 

# 2J ± (

^ Staf f 

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## I 2898 6 Exterio rPain t Nort h Arro w 

### Omah a Lea d Sit e •Goo d 

### Sit e Sketc h 0 Poo r Samplin g Address : 221 2 OHI O ST Q] No t pain t Sampl e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Firm : Sample s Collecte d RYASCPXA-2898 6 RYBSCPXA-2898 6 Ft F2 

### 36 ^ 3 \ 1 pp m pp m 

## D D Date: Time : 

### b/t7/h 7 Z:l.5f>P i RYCSCPXA-2898 6 RYDSCPXA-2898 6 Bl B2 

### \l^ H (^H O pp m pp m 

## D D Sample s Analyze d RDZSCPXA-2898 6 RqgOGPXA-e090 0 F!PZOCrXA-2090 C DZ OE PZ 

### l'?52
.

— pp m pp m pp m Numbe r of Sample s = 

## D D ^ 

## D D D 

# o XR F Unit : 6S^ Z Book : Date : ^I2lj0 7 Tim e Staf f 

# 2 ^ M^ U /^ 3

Legend : F1 = Fron t Left , F2 Fron t Right , Bl = Bac k Left , B2 = Bac k Righ tDZ = Dri p Zone , GZ • Garden , PZ = Pla y Al l quadrant s ar e as viewe d frqAMaftti^t , facin g property -4 "f ^

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. 

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% •! •o * COASTA L '*'/i , . yEHVIBONMENTA L

^ ' "ROl* ­ CROUP
. INC
. 

### Consen t Fo rAcces s T o Propert y RIGH TO F ENTR YTO PREMISE S 

### Granto r(th e propertyowner ) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : 

# pyip^ h

Owner' s Name : Daytim e Phone :



# ftr^»-ify^
. y^y syyy^ \

Addres s o fPropert y covere d b ythi s Agreement : 

# ;J;^17 ^ /^k( 6 s ^ PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d maypos e a healt h hazard
. Th e area(s ) wil l b e excavate d t o remov e contaminate d soil
. Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition
. Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d byUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins
. Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert yha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin g th e work
. Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 o f2— * > .s^^

^ ,itosr<
. 

### • COASTA L ENVIRONMENTA L CROUP
. INC
. 

### Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; Remov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t ma ywis h t o save ; Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d b yEPA ; Abid e b yhealt h an d safet yguidanc e provide d b yEPA ; I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. Allo wvideotapin g and/o rphotographin g ofth e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yofth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (877 ) 234-6270
.

Q i gran t acces s t o mypropertie s n I d o no t gran t acces s t o m ypropertie s 

# ^b4 k asi
. Signatur e Date Signatur e Date

G I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required
.

Pag e 2 o f2

## Restoratio n Agreemen t Th e purpos e ofthi s agreemen t is t o provid e amutua l agreement as t o condition s ofth e propert y prior to remediationactivities
. Thi s wiil als o serx' e a s documentatio nfo r the purpos e of assuring tha t restoration activitie s ar e completedt o the satisfactio nofth e propert\ ' owne r an dthe UnitedState s Environmenta l ProtectionAgenc y (EPA)
. Propert y ID : "Sy^^^y Propert y Address : ^-^NQDW O 

### 'Sl ^ Owner : ^.^^^^^ ^ ^- ^ Q^t^ Q 

## Phone:(^^N^ ^UF
O

nthe attache ddiagram(s ) indicat e area(s ) t o excavatedan ddept hol" excavation , locationof al l know n utilities , subsurface features , syrface structure s an dlandscaping features , acces s location(s ) t o be use db y contractor , an dthe directionof North
. Indicat e distances , depths , materia l types , etc . Indicat e digita l photo s b

y referencin g the photo-lo g numbe r wit ha narrow indicating directionof view
. Item s T o B e Remove d B yOwne rBefor e Star t O fRemediation : (Us e additiona l sheet s a s necessary ) Th e removal , storage , disposal , and/o rretur n o fthes e item s i s th e Owner' s responsibility
. Item : Item : Item : Item : 

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Pag e 1 of
.COASTA L CMOU P> H < 

### Item s To B e Remove d B yContracto rDurin g Remediatio n An d No t Replace d (Us e additiona l sheet s a s necessary ) Item : 

# ^./i n .Pl fbkn^ i ^^.:^ - .-_ ^ Item : 

# y ^ Item : y Item : 

# y / Kem : 

# y Item : / 7 Item : / Item : / Item : /

/ Item : Item : Item : Item : Item :

Pag e 2 of
.< ^ COASTA L
• MVlNOMM I NTA L cM o u rt N C 

### Item s To B e Remove d ByContracto rDurin g Remediatio n An d Replace d (Us e additiona l sheet s as necessary ) Item : 

# ^y y i^ i p, o 

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. Item : 

# 1^ ^

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# Q Z \ Item : "^^^.^^ ^

' Item : y ^ Item : ^ ^ Item :

1 ^

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### Item : y Item : / Item : / Item : / Item : / Item : Item : Item :

Pag e 3 of
.( ^ ^ COASTA L l*avtROM'*t*«r« L 

### Landscap e Inventory (Us e additiona l sheet s a s necessary ) 

## Ite m

Pre-existin g propert y area , tha t will be excavated , tha t is covere dwit hgrass .

Numbe r of tree s > 2 inc h trun k

diameter

Number o f tree s < = 2 inc h trun k

diameter

Number of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attachasketcho f the sprinkler layout
.

Number of an dsize o f eac hgarden / flowe r bed area . Attachasketchof relativ e size s an dlocations
. 

## Quantity 

# y

#

* *



### #

/ 

## Unit

Squar e fee t

Eac h

Eac h

Eac h

Eac h Squar e Fee t 

## Condition/Type/Specie s

•­

j

Pag e 4 of
.I COASTA L MV(|ION'*tNT* l C * O U rIM C 

## Ite m Agree dupo nvalu e o f plan t material s no t to b e replace dbv contractor . Not e thi s valu e will b e usedto issue aplan t vouche r to th e propert y owner . Agreedupo nlis t o f plan t material s tha t will b e replace db y contractor . B e ver y specifi c an ddetailed
. Include asketcii of wer e eachplan t wil l b e placed b

y the contractor . Agreedupo nare aof propert y t o b e replace d wit hgras s sod
. Include asketchof the area(s ) t o b e replace dwit h gras s sod
.
Are aof Cit y o r Count y propert y to be landscaped per their requirements
. Include asketcho f the are a(s )

Easemen t Area , to be excavate d 

## Quantity

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## Uni t

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## Condition/Type/Specie s

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D Chec k th e boxr fOwne rdoe s no t wan t CE G t o documen t interio rfoundatio n wall s an d possibl e pre-existin g damage
. B ycheckin g thi s boxCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundation crack s o rfissures
.

0 ^ nI agre e nI d o no t agre e 

# ^N(<^< ^ Owner' s Signatur e Dat e ^Contractor' s Signa^r e Uat e 

### Pag e 6 of
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## 1^1 Dept h 

## _L 5 i(^
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# B 9 Dept h

L ^ i M 'o Q Sampl e are a Dept h

Sampl e are a Dept h

L<>p,. A 

# 1

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 402 5 Mod e SOI L Tim e 2008-09-1 5 16:0 9 Duratio n 30.3 1 Sequenc e Fina l Flag s BVI D # 2898 6 ADDRES S 221 2 Ohi o s t QUAD/ZON E easemen t INSPECTO R lope z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 106.49 6 ±13.39 1 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 102.58 3 Supervise d By : 

## Certificat e o fVerificatio n

402 6 SOI L 2008-09

- 1 5 16:1 0 30.2 7 Fina l 2898 6 221 2 Ohi o s t easemen t lope z 6 CLEARANC E

± Erro r
± 13.28 0

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 141.62 0 Supervise d By : 

## Certificat e o fVerificatio n

402 7 SOI L 2008-09-1 5 16:1 1 30.3 3 Fina l 2898 6 221 2 Ohi o s t easemen t lope z 6 CLEARANC E

± Erro r
± 15.17 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 402 8 Mod e SOI L Tim e 2008-09-1 5 16:1 1 Duratio n 30.2 4 Sequenc e Fina l Flag s BVI D # 2898 6 ADDRES S 221 2 Ohi o s t QUAD/ZON E easemen t INSPECTO R lope z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 141.11 9 ±15.13 1 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 402 9 Mod e SOI L Tim e 2008-09-1 5 16:1 1 Duratio n 121.1 5 Sequenc e Fina l Flag s AVERAG E Av g o f4025-402 8 ADDRES S 221 2 Ohi o s t QUAD/ZON E e easemen t INSPECTO R lope z DEPT H 6 SAMPL E TYP E CLEARANC E NOT E

Supervise d B y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 127.98 3 Supervise d By : 

## Certificat e o fVerificatio n

403 0 SOI L 2008-09-1 5 16:1 5 30.4 6 Fina l 2898 6 221 2 Ohi o s t B l lope z 1 3 CLEARANC E

± Erro r ± 14.32 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 170.31 9 Supervise d By : 

## Certificat e o fVerificatio n

403 1 SOI L 2008-09-1 5 16:1 6 30.0 4 Fina l 2898 6 221 2 Ohio s t B l lope z 1 3 CLEARANC E

± Erro r
± 16.11 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 264.59 2 Supervise d By : 

## Certificat e o fVerificatio n

403 2 SOI L 2008-09-1 5 16:1 6 30.0 5 Fina l 2898 6 221 2 Ohi o s t B l lope z 1 3 CLEARANC E

± Erro r
± 20.14 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 120.37 8 Supervise d By : 

## Certificat e o fVerificatio n

403 3 SOI L 2008-09-1 5 16:1 7 30.0 8 Fina l 2898 6 221 2 Ohi o s t B l lope z 1 3 CLEARANC E

± Erro r
± 13.94 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 403 4 Mod e SOI L Tim e 2008-09-1 5 16:1 7 Duratio n 120.6 3 Sequenc e Fina l Flag s AVERAG E *Av g o f4030-403 3 ADDRES S 221 2 Ohi o s t QUAD/ZON E # 1 INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

P b Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 403 5 Mod e SOI L Tim e 2008-09-1 5 16:2 0 Duratio n 30.0 7 Sequenc e Fina l Flag s BVI D # 2898 6 ADDRES S 221 2 Ohi o s t QUAD/ZON E D Z INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P b 146.30 2 ±15.07 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 403 6 Mod e SOI L Tim e 2008-09-1 5 16:2 2 Duratio n 30.0 4 Sequenc e Fina l Flag s BVI D # 2898 6 ADDRES S 221 2 Ohio s t QUAD/ZON E D Z INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m±Erro r P b 183.30 6 ±16.99 0 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 199.04 6 Supervise d By : 

## Certificat e o fVerificatio n

403 7 SOI L 2008-09-1 5 16:2 2 30.1 2 Fina l 2898 6 221 2 Ohio s t D Z lope z 1 3 CLEARANC E

± Erro r
± 17.10 8

# Therm o SCIENTIFI C Therm o Fishe r Scientifi c 90 0 Middlese x Turnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 191.17 3 Supervise dBy : 

## Certificate o f

Verification

403 8 SOI L 2008-09-1 5 16:2 3 30.0 3 Fina l 2898 6 221 2 Ohio s t D Z lope z 1 3 CLEARANC E

± Erro r ± 16.87 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 403 9 Mod e SOI L Tim e 2008-09-1 5 16:2 3 Duratio n 120.2 6 Sequenc e Fina l Flag s AVERAG E Av g o f4035-403 8 ADDRES S 221 2 Ohi o s t QUAD/ZON E 

## pz - INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

P b Supervise d B y

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 154.73 2 Supervise d By : 

## Certificat e o fVerificatio n

404 0 SOI L 2008-09-1 5 16:2 4 30.0 8 Fina l 2898 6 221 2 Ohi o s t B 2 lope z 1 3 CLEARANC E

± Erro r
± 15.46 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3208 9 Readin g N o Mod e Tim e Duratio n Sequenc e Flag s BVI D # ADDRES S QUAD/ZON E INSPECTO R DEPT H SAMPL E TYP E NOT E

pp m P b 102.59 9 Supervise d By : 

## Certificat e o f Verificatio n

404 1 SOI L 2008-09-1 5 16:2 5 31.0 4 Fina l 2898 6 221 2 Ohio s t B 2 lope z 1 3 CLEARANC E

± Erro r
± 13.03 9

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 404 2 Mod e SOI L Tim e 2008-09-1 5 16:2 6 Duratio n 30.3 1 Sequenc e Fina l Flag s BVI D # 2898 6 ADDRES S 221 2 Ohi o s t QUAD/ZON E B 2 INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

pp m ±Erro r P

b 145.60 4 ±15.08 1 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o f Verificatio n XL3t-3208 9 Readin g N o 404 3 Mod e SOI L Tim e 2008-09-1 5 16:2 7 Duratio n 30.2 8 Sequenc e Fina l Flag s BVI D # 2898 6 ADDRES S 221 2 Ohio s t QUAD/ZON E B 2 INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

Erro r pp m P b ± 14.49 4 135.17 6 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e o fVerificatio n XL3t-3208 9 Readin g N o 404 4 Mod e SOI L Tim e 2008-09-1 5 16:2 7 Duratio n 121.7 1 Sequenc e Fina l Flag s AVERAG E Av g o f4040-404 3 ADDRES S 221 2 Ohi o s t QUAD/ZON E « 2 INSPECTO R lope z DEPT H 1 3 SAMPL E TYP E CLEARANC E NOT E

P b Supervise d By :X 

# m Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc
. %
. •. ^ www.coastalhazmat.co m ^PBoit^" ^ COASTA L 'in a ENVIHONMENTA L CROUP , INC
. 

# EXECUTIV ESUMMARY ; BVI D #2898 6 - (221 2 OHI O ST )
N o Issue s o r Concern s [ ^ Issues/Concern s
Detai l Explanation :

- N O ISSUE S PENDIN G

# .^EP A EP APropert > Clos e Ou t For m Propert yft : y)(yRSL o Propert y Address : ^\ ^ Oh\ Q ^) '
. Date/Time : Owner' s Name : /jryr-^^ ^ ff^

- V^XAJ U Quad s Excavated : 'Q>\
. xgaS)
. ^" ^ Contracto r Crou p Qj-y-^ nQ \lf^,An>,rMrj i irt^cJ L
Excavatio n Genera l Ye s N o 1 I fneccssiry , wer t th e correct quadrant(s ) excavate d an d resiored ? 

## y 2 Ifnecessary , wer e th e correct area s ofdri p zon e excavate d an d restored' ^ 

## y Gradlp g So dto dVetetatio n Ye s N o Doe s the gradin g aroun dthe perimeter ofth e hous e in
. excavate darea s generall y slop e awa y fromtb e house ? VAcu^
. XoMJt > V s >>-<- AaLIL V rc^W^^crn
. gw ^ Ha s so dbee nlai di nall area s tha t wer e excavated ? -Se? : 

### c l re-^vco/e-X 

## /J 4 3
. Doe s the so dappear to b e generall y healthy an dgrowing ? (Onl y evaluate i f inspecie da t a3 0 

## 5 ^ day lime period ) 

### itt 4 4 Are soddedarea s generall y fuman devenl y graded ? 

### y ^ 5 Are the joint s betwee nthe so dstrip s generall y tight ? (Onl y evaluat e ifinspecte da t a3 0 da y tim e period ) _^___
_ 

## r 6 Wa s the propert y grade dsuchtha t water \

* il l no t poo l o nthe property ' 7 Wa s damig e to landscapin g o r plan t material s avoided' ' 

# y Gates , Fepce aan dReUinlD £Wall s \ei No D o gate s ope nan dclos e freely'^ (Ifapplicable ) 2 Were all gate s o r fence s takendow ndurin g restoratio nactivitie s reinstalled ? (I f applicable ) 

# W ^ 3 Wa s dam»ge to gate s o r fence s avoided ? (Ifapplicable ) 4
. Wa s damtg e to retainin g wall s avoided ? (Ifapplicable ) Foupdation , SidicKan dGuCler s Yes N o I
. Wa s damtg e to the sidin g o r trimavoided ? 2 Wa s damag e to the foundatio navoided ? 

# jm: ^ 

# X \VDIA ^ 

# ' y 

# vi^ y ­ 3 Wa s damag e t o window s avoided' ' 

# i k 4 Wa s damag e t o window s o r door screen s avoided' ' 

# ^ P ^ 5 Wa s damag e tc downspout s o r downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ves N o Wa s damag e t o driveway surface s avoided' ' 

### A/ ^ 2
. Wa s damag e t o walkwa y surface s a\'oided ? 

# y

## O voer s comments :

Inspectio nnotes :

1 If^ld ^ - OvO^^ ^ ^^^ ^ ^ ^ ^'i ^ pr^towc s o^i^er/f[to J Ou)'- ^

Removal andresloralio naclivale s complel e includin g ihe 30-da y sodwarranty EP A R,^:,stumt^f/^^^-^^^^^^^-^ ^ Hal e

## Propert yCompletio n Agreemen t
Thi s agreemen l document s th e complclio n o fremedia l activitie s perlbime d o n m yproperly
. M ysignalur e wil l designat e tha t I a m satisfie d wit h th e resloratio n o fin yproperly , an d tha i n o item s ar e i n questions , now , o ra l an ylim e i n th e future , excep l thos e ilem s liste d below , ifany
.

Propert y ID : 

# z^7^) ^ Propert y Address ; 2- 2 / 2
. 

# ^^/ o i " 

# t Owner : I T «SL.<5~ T €
. I T 

# G s\
. 

# ?

- o\ Phone : 

# ? H (

# ^^^ i Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :
Additiona l Comments :

I agre e restoratio n i s completed , excep t a s note d I I d o on t a(;re cresloratio n i s complete d

Owner' s Signatur e I Dat e Cdntractor' s Signatur e Dal e I